OVERVIEW

We will require a photocopy of the front and back of your insurance card(s) in your medical chart to submit your claim. It is the patient's responsibility to ensure coverage under his or her benefit plan. It is the patient's responsibility to update Minnesota Ophthalmic Plastic Surgery Specialists of any termination or changes of insurance coverage and to supply the clinic with documentation of new coverage.

If you do not carry insurance or are not submitting your claim to insurance, payment for your consultation must be made in full to Minnesota Ophthalmic Plastic Surgery Specialists and payment for surgical services must be paid in full 10 days before your planned surgery date. If you are uninsured, call us about payment details.

If your procedure will be covered by insurance, claims will be submitted to your insurance company and payments and responsibilities will vary depending on your coverage plan, hospital or surgery center location, deductible, and other factors.

HEALTH PLAN PARTICIPANTS:

Blue Cross Blue Shield of Minnesota/ Blue Plus
Fairview Physician Associates
HealthPartners/Group Health
Great West
Medica
Medicare
Metropolitan Health Plan
Minnesota Medical Assistance/ MN Care
PreferredOne Community Health
UCare Minnesota
United Healthcare
Wisconsin Medical Assistance

This is a listing of the insurance companies for which we are a provider or a preferred provider. If you do not see your insurance company listed here, call your insurance company for verification of coverage at our clinic, Minnesota Ophthalmic Plastic Surgery Specialists, Dr. Eric R. Nelson or Dr. Andrew R. Harrison. Some insurance policies may require a physician referral for coverage of a specialist consultation. Ask your insurance company about your coverage and benefits. If your insurance company is unable to help you, call our office at 952-925-4161 and we may be able to assist you.

PRIOR AUTHORIZATION

Some insurance companies may require prior authorization for some procedures. Prior Authorizations must be approved before your surgery is scheduled. Prior Authorizations prove that your condition and procedure fall under the guidelines for medical necessity laid out by each independent insurance company. That is to say, it is to establish that your procedure is to correct a medical condition and is not cosmetic in nature.

Medical documents, including photographs and visual fields exams, and medical records are submitted to insurance to determine medical necessity. It may take up to four weeks for processing. You may receive a letter upon approval or denial. Before we can schedule you for your surgery, we will require either a written letter of approval from your insurance company or a verbal confirmation and authorization number from your insurance company if a letter is not sent. If you require prior authorization for a procedure, we cannot schedule your surgery until authorization is obtained from your insurance company. Prior Authorizations may not guarantee coverage and final coverage is determined at the time of claim submission. It is the patient's responsibility to confirm their own coverage under their individual insurance plan.

A SPECIAL NOTE FOR MEDICARE PATIENTS AND PRIOR AUTHORIZATIONS

At this time, Medicare does not require prior authorization for surgeries we perform. Medicare has specific guidelines for what is to be considered a medical necessity. If you do not meet these guidelines, you will be informed before your surgery is scheduled.

If you have a secondary insurance company, it is a rule of thumb that they will follow Medicare's decision. At this time, they do not require Prior Authorization if your primary insurance company is Medicare. Speak to your secondary insurance company to understand your benefit plan.